BACKGROUND AND PURPOSE:

• Alder et al. (AJOG, 2020) examined
  • Long-term risk of residual/recurrent high-grade CIN among women previously treated for CIN 2/3 and association with margin status, posttreatment presence of high-risk HPV and other comorbidities

METHODS:

• Prospective cohort study
• Participants
  • Confirmed CIN 2/3
  • Underwent conization (2000 to 2007)
• Study design and data analysis
  • Data from the Swedish National Cervical Screening Registry included
    • Primary histopathologic finding | Treatment modality | Comorbidity | Age | High-risk HPV status
  • Kaplan–Meier curves were used to plot cumulative incidence of residual/recurrent high-grade CIN
  • Management was standardized and based on margin status
  • Treatment modalities for CIN2/3: Electrosurgery with contoured-loop excision of the transformation zone (C-LETZ) most commonly used |  Electrosurgery with a diathermy needle | Laser (CO2) conization | Knife excision (rarely used)

RESULTS:

• 991 women included
  • Residual/recurrent high-grade CIN or worse: 111 patients
  • Median follow-up: 10 years (maximum 16 years)
• Positive/uncertain margins had a higher risk of residual/recurrent high-grade CIN or worse vs negative margins
  • Adjusted Hazard ratio (HR) 2.67 (95% CI, 1.81 to 3.93)
• Residual margin location: Risk of residual/recurrent dependent on anatomical localization
  • Endocervical
    • HR 2.72 (95% CI, 1.67 to 4.41)
  • Both endocervical and ectocervical
    • HR 4.98 (95% CI, 2.85 to 8.71)
  • Only ectocervical margins (positive or uncertain)
    • Risk did not increase significantly
• Comorbidities independently associated with residual/recurrent high-grade CIN or worse
  • Autoimmune disease
  • Human immunodeficiency viral infection
  • Hepatitis B and/or C
  • Malignancy
  • Diabetes
  • Genetic disorder
  • Organ transplant
• Significant increased risk noted with positive high-risk HPV vs positive high-risk human papilloma virus findings but negative margins

CONCLUSION:

• Incompletely excised CIN 2/3 is associated with greater risk for residual or recurrent high-grade CIN, or worse
• The authors suggest that

Subdivided margin status might be used together with hrHPV status, and consideration of comorbidities to identify women at highest risk who are in need of re-treatment

Learn More – Primary Sources:

Incomplete excision of cervical intraepithelial neoplasia as a predictor of the risk of recurrent disease—a 16-year follow-up study

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